How Would You Handle This Situation?

[jdb in AZ]

A family member in mid-70's (call him Fred) has been in the hospital nearly two weeks with heart A-Fib and pneumonia, fluid build-up around the heart and lungs. Drs tried to jump-start his heart (reset its rhythm) and he ended up coding. The drs were able to bring him back after two mins of CPR. Fred has finally been moved from ICU to a regular room, and is quite homesick. He's probably going to be released Monday and the dr is strongly recommending acute physical rehab (working with P.T., O.T., and speech therapy, but the dr acknowledges it's up to the patient. The family is in total agreement with the dr's recommendation for rehab but Fred insists he's just as strong as he was before he got pneumonia. He's not. It took three strong adults to help him use the potty today, but he thinks his wife can help him when he gets home to his "normal routine." She can't. A dr has told her not to try to lift him because it would mess up her back Also, Fred has lost 80 lbs since he's been in the ICU. Part of that is draining off excess fluids from pneumonia, and improved kidney function after the nephrologist was concernes he'd need dialysis. Fred's adult DD has tried to talk some sense into him but he's being stubborn, and his wife refuses to give in to him. What would you do?

 

[barkley]

Fred's adult DD has tried to talk some sense into him but he's being stubborn, and his wife refuses to give in to him

do you mean that his wife refuses to NOT give in to him (not say 'no' to him despite the circumstances)?

 

[jdb in AZ]

do you mean that his wife refuses to NOT give in to him (not say 'no' to him despite the circumstances)?

She doesn't want to risk her own physical and emotional health to allow him to come home before he's stronger.

 

[Marrila]

She doesn't want to risk her own physical and emotional health to allow him to come home before he's stronger.

This is reasonable. He may not like it, but he needs to go to rehab to get stronger. He needs to handle as much as is possible of his own activities of daily living.
Can the spouse drive to the rehab facility? Are daily or every other day visits possible? He may be more open to the situation if he knows regular visits are part of the plan.

 

[fla4fun]

I think he’s afraid, and is thinking this is akin to putting him in a nursing home instead of the rehab it actually is. He needs to understand that there is a difference between the two and that the goal of going to rehab in the first place is to get him strong and healthy enough to take care of himself. Sometimes people can be very fearful that if they go to rehab, they won’t ever get to go home again. That should be addressed first.

If I were the wife (and any children who may be assisting with care) I would make a list of what the costs would be to have full time rehabilitation care at home. She needs to remain firm that she is not physically able to give him the care he needs, so it will either come from a rehab center or home care. Home care is going to be extremely expensive and probably not covered by any insurance since there is a suitable alternative. Perhaps the dollars and cents will get through to him if nothing else will. Also, how will HE take care of HER if something happens while she is trying to help him heal?

My dad was enormously stubborn about everything, but he did have the good sense to agree to rehab when he needed it. My mom was not usually stubborn and also agreed to rehab. I hope “Fred” will see sense and not wish any harm on his wife by going against the doctor’s advice. I wish them luck through their journey.

 

[HopperFan]

Non-Negotiable. If he wants to go home and not a nursing home, then he needs to do rehab and get better. Make the arrangements and make the transfer and tell him the harder he works, the faster he'll be home.

On flip side he'll feel abandoned and unwanted and sorry for himself. It is important to make daily visits, and hopefully from multiple people. Take him treats to sit and enjoy together as you would at home. I used to take my MIL blueberries in the morning and sit with her while she ate breakfast. We would take her ice cream cups some evenings, we'd all have one, like we would have a dessert after dinner with her. Have family and friends send him cards of encouragement and they can't wait until he is home.

While he is there explore some options of getting services for him once he moves home if there will be a need. Perhaps an aide to come in and help with the physical work of showers. Nurse visits maybe weekly to check him over and give recommendations to him to help in his progress.

Been there with a few and his wife needs support & help.

 

[barkley]

She doesn't want to risk her own physical and emotional health to allow him to come home before he's stronger.

i'm SO GLAD to hear that she's self aware of her own physical and emotional health to put this boundary in place.

Non-Negotiable. If he wants to go home and not a nursing home, then he needs to do rehab and get better. Make the arrangements and make the transfer and tell him the harder he works, the faster he'll be home

unless someone has a non revocable active power of attorney in place (not the type that says it is in force when someone becomes incapacitated b/c you have to get doctors to testify to the patient's mental incapacity to-they are very hesitant/entirely resistant to except in extreme situations in my experience-and then get a court ruling if the person in question at all objects or is resistant) or a full guardianship you can't force or 'non negotiate' someone in a situation like this (even with one or both of the above in place -in some states placement in any rehabilitative or nursing facilities are not permissable without additional court review and approval).

that said-if a senior person is in the hospital and the doctors are saying rehab is needed and the patient is claiming that they can safely go home but the family knows that is in no way/shape/form feasable AND could create a dangerous situation for ANOTHER senior in the home (his wife in this situation)-speak to the hospital's social work staff and request an Adult Protective Services intervention. aps can do an assessment of the home and of the circumstances. sometimes hearing from a completely independent entity about the realities of what one wants vs. what they need AND how what they are pushing for will actually endanger their partner/spouse as well as may be interpreted legally as elder abuse on THEIR PART towards their partner/spouse can be a more productive discussion.

 

[Pea-n-Me]

This is very common. I’d insist he has to go to short term rehab. Wife needs to care for herself, too.

 

[Mackenzie Click-Mickelson]

What about an in home health aid? The wife still can't physically help him but depending on just how much care he needs there are various levels of in home health aids they could look into. Would that be covered by whatever they have?

I'm empathetic towards the fear situation. Neither my grandmother nor my grandfather ever actually went home after physical rehab (for my grandfather) and hospital/treatment center (for my grandmother).

My husband's grandmother was incredibly fearful of going to the hospital for a foot issue as her worst fear was never going home afterwards. She was retaining fluid and had been undergoing treatments over time if she had consumed too much sodium in a short enough time period. The foot issue became too much of a concern and they did make her go into the hospital (at that point she had already been living with my mother-in-law and step-father-in-law). She never made it home and passed away in the hospital. In her case it wasn't the rehab facility but still I understand the fear.

There's coming to grips with needing care that someone else can't provide and also looking into if a different avenue for that care could potentially be provided. If the care is too great it's too great and a facility would be required.

 

[HopperFan]

i'm SO GLAD to hear that she's self aware of her own physical and emotional health to put this boundary in place.





unless someone has a non revocable active power of attorney in place (not the type that says it is in force when someone becomes incapacitated b/c you have to get doctors to testify to the patient's mental incapacity to-they are very hesitant/entirely resistant to except in extreme situations in my experience-and then get a court ruling if the person in question at all objects or is resistant) or a full guardianship you can't force or 'non negotiate' someone in a situation like this (even with one or both of the above in place -in some states placement in any rehabilitative or nursing facilities are not permissable without additional court review and approval).

that said-if a senior person is in the hospital and the doctors are saying rehab is needed and the patient is claiming that they can safely go home but the family knows that is in no way/shape/form feasable AND could create a dangerous situation for ANOTHER senior in the home (his wife in this situation)-speak to the hospital's social work staff and request an Adult Protective Services intervention. aps can do an assessment of the home and of the circumstances. sometimes hearing from a completely independent entity about the realities of what one wants vs. what they need AND how what they are pushing for will actually endanger their partner/spouse as well as may be interpreted legally as elder abuse on THEIR PART towards their partner/spouse can be a more productive discussion.

I wasn't speaking legally .....

I think the family can resolve this without pulling in others to tell him he is committing elder abuse ....

They need to be firm with him that he needs rehab, at a rehab center.

 

[Pea-n-Me]

Drs tried to jump-start his heart (reset its rhythm) and he ended up coding. The drs were able to bring him back after two mins of CPR. Fred has finally been moved from ICU to a regular room

I’m sure this is part of why they think he’d be better off being under medical supervision for a little while longer even if he no longer requires acute care anymore. People can still have issues after they leave the hospital and I’d hate to see anything like that happen to his wife. I’m sure it’s been a stressful time for her and she could use the time while he’s in rehab to rest and regain some of her strength. He may not be cooperative with aides if he prefers his wife to do everything for him.

 

[barkley]

Fred's adult DD has tried to talk some sense into him but he's being stubborn

They need to be firm with him that he needs rehab, at a rehab center.

my concern at this point would be for fred's wife (fred has made his own choices about declining the medical care the doctor recommends/fred's wife WANTS to follow her doctor's recommendations for her own wellbeing). it sounds like fred is already against this and if his children try being 'firm' with him he will perceive this as his children attempting to parent him at which point he's likely to totally shut down to any form of reasoning, will upon release end up at home against everyone's best judgement and either through guilting his wife or her simply responding with natural human kindness to one of his physical needs she will end up SEVERLY injured and hospitalized/in need of rehab herself.

 

[Pea-n-Me]

In many situations, at some point, the elderly, hospitalized person does become somewhat dependent on their family and the tables do turn a little bit, but that comes with advanced age, illness and incapacity, etc. He needs to count his blessings that he has a wife and children to help him and try to be more cooperative with care and trusting that people are trying to do what’s best for him. It’s not always easy by any means. Besides working with these situations we’ve had them happen in our family, too. Some people will never go with the flow but it will unfortunately make for a contentious period and a lot of angst for everyone if he insists on doing everything his way all the time without concern for anyone else. The wife’s needs need to be taken into consideration here, too. And hopefully there will be a time when he’ll be better and able to come home safely. Now may just not be that time yet.

 

[ShaneDJ]

We went through a very similar situation with my dad in AZ (similar ages, was very sick in the hospital, lost lots of weight and strength, was demanding to go home, etc.).

All I can say is that it is critical that the elderly patient, in this type of circumstance, NOT be released home.

What we found is that they must go into either skilled nursing facility or an assisted living center. Both have daily living help, meals, nurses, and sanitary (bathroom) help. You can still visit your loved one daily.

The cost for hiring daily "in-home" help was more than having them go into a facility.

It takes the daily care burden off the (also elderly) spouse and other family members, and gives your loved one the best chance to gain strength and improve, while getting daily care and physical therapy.
Good luck...(it's not easy).